Normalization of menstrual pattern after liver transplantation: consequences for contraception

Abstract

We studied menstrual abnormalities before and after liver transplantation in 31 women. The incidence of menstrual abnormalities is high before transplantation. Soon after transplantation, in most patients below 45 years of age, the menstrual pattern normalizes. Pregnancy can occur. Consequently, tubal sterilization should be avoided in transplant candidates. After transplantation adequate contraceptive measures should be taken to prevent unwanted pregnancy.

PIP: Menstrual abnormalities, such as menometrorrhagia and amenorrhea, occur with great frequency before liver transplantation due to chronic liver disease. This study of 19 patients, of whom 2 had prior hysterectomies and 6 had regular cycles, reported that only two 41 year old women still had irregular menstrual patterns after transplantation. There was no endometrial carcinoma. Thirteen had regular menstrual cycles with a median of 8 weeks afterwards, and two had a secondary amenorrhea at the ages 38 and 41. Also, two patients received cervical conization due to carcinoma, and two had healthy babies even though one had some cholestasia between the 36 and 38th weeks. Preoperative procedures included 5 curettages for menometrorrhagia, 1 prolapsis operation and tubal sterilization. The 12 patients over 45 years, of whom 1 had a hysterectomy, never regained a menstrual cycle after transplantation. Other preoperative procedures included 4 curettages for menometrorrhagia and postmenopausal blood loss, 1 cervix conization, 1 prolapsis operation, and 2 tubal sterilizations. It is suggested that contraception be used for the 1st year following transplantation, and that sterilization is not necessary when transplantation is an option; this would minimize the high rate of hysterectomy in primary biliary cirrhosis.